Thursday, July 18, 2013

The Calamity

Warning: This is the story of the end of a birth gone wrong. If you don't want to read about frightening things that can happen during labor, please stop reading. If you want to read on, click through.

After having a low risk pregnancy with no complications (aside from pelvic girdle pain) and birthing a healthy baby girl without any drugs, I hardly expected to run into problems delivering the placenta.

After pushing to deliver the placenta, I started moaning, “Owwww, owwww. Is this supposed to hurt?” I heard the midwife say, “What is this?” Then everything happened so fast that the sequence of events is a bit jumbled in my head. I can’t remember if I was prompted or if I just volunteered it, but I said, “It hurts in my UTERUS.” P said, “Get doctor so-and-so STAT!”

They say that real life doesn’t look anything like TV medical emergencies, but let me tell you, what happened next felt exactly like an episode of E.R.

People started swarming into the room. A blonde doctor rushed in and started asking urgent questions:

To the midwife- “Did you pull hard on the cord?” (no)

To me- “Is this your first child?” (yes)

“When was your last ultrasound?” (21 weeks)

“Did you have an epidural?” (no)

She starts ordering everyone around and says to me and Jon, “The placenta hasn’t detached and your uterus is outside your body. We are going to get you into the operating room and try to replace your uterus manually. If that doesn’t work, we’ll try surgically. I will do everything possible to save your uterus so you can have more children, but if I have to remove your uterus to save your life, I will.”

At least we knew exactly what was going on. I might die, I might lose my uterus, I might have surgery, or it might go back in. I hardly had time to be scared, and I knew my fate was completely out of my control so I tried to be as calm and cooperative as possible. I had been in the operating room once before in that hospital for my appendectomy, and I had come out ok. I had to trust them. I said my fingers were getting tingly. I could feel that I was losing blood and was on my way to passing out.

Someone took Adele off my chest. At first Jon thought he could go along, like for a c-section, but they said no. He said, “I can’t go- I have to wait here. I love you,” and kissed me as they wheeled my bed out the door. I saw Adele naked and wiggling, crying, on the warmer.

I signed consent forms as they wheeled me down the hall. The operating room lights were blindingly bright. I already had a hep-lock but they put in more for other IVs. They moved me from the delivery bed to the operating room bed, which took 6 or 7 people- one person had to move the placenta and my uterus at the same time. I was saying, “Give me drugs. Knock me out. Owww owww...”

I later learned that the doctor didn’t want me intubated and under general anesthesia for a few reasons. One is that the uterus can react unpredictably, and second is that I would have had to recover in the ICU. Since my condition was so specifically obstetric, she wanted me to remain in Labor & Delivery for recovery because the ICU would never see something like this. Perhaps the fact that I had eaten during labor (2 or 3 small peanut butter cups) was also a consideration, though she didn’t mention that. Instead of general anesthesia, they gave me lots of drugs (ketamine and nitrous oxide at least) to hopefully prevent me from remembering and presumably to reduce the pain too. As far as I was concerned, the drugs weren’t acting fast enough because I could still feel the pain.

Meanwhile, Adele was moved to the nursery and the doula followed her. Jon called his sister who lives only a few hours away, then called my parents. My parents were just pulling into the parking garage at the hospital, since we had told them to arrive around lunchtime on Thursday. His sister made plans to get here as soon as possible.

Our regular midwife, C, came to see how we were doing and ran into Jon in the hallway looking frantic. He quickly explained what happened and C came into the operating room to find out what was going on and give him updates. After about ?? minutes, someone came out and told Jon they had successfully separated the placenta and replaced my uterus. But then about 10 minutes later, they came back and said the uterus had inverted again and they were trying again to replace it. Then 20-30 minutes later they said they had put it back in again.

By that point, my parents were with Adele and the doula in a postpartum room. They spent most of the time that I was in the operating room taking turns holding her, which was comforting to me.

My experience in the operating room was, well, trippy. There were so many people around me giving urgent orders and answers and doing things all at the same time. I could feel they were prepping my abdomen for possible surgery because it hurt when they touched my belly. I remember C standing by my head, telling me who she was and what was happening. I probably remember that because she was the person in the room I knew best, and I knew that she hadn’t been there when the calamity started. I remember the doctor telling me my uterus was back inside my body (but I don’t know if it was the first or the second time). I heard moaning, and I realized it was me. Then there was a blur of faces and lights and voices and I thought, Am I dead? Did I actually give birth? Was I ever even alive or did I imagine this entire experience I thought was reality?

I latched back onto reality (kind of) when I heard Jon's voice. He was able to join me in recovery. I turned to him and said, “You have four eyes.” Then I turned to the person on my other side and said, “You have three eyes.” I had double vision for a few hours afterwards. The blonde doctor came in and talked to us. She explained that I had a uterine inversion and severe hemorrhage. I received 3 units of packed red blood cells. They were able to successfully replace my uterus without surgery. They inserted a Bakri balloon to help support the uterus and control and monitor the bleeding, but they also gave me several kinds of drugs to contract the uterus down to help stabilize it. The balloon would stay in about 24 hours, during which time I had a catheter and couldn’t get up (as if I’d want to!). She said if everything went smoothly from there, which she expected it would, then our hospital stay wouldn’t actually be much longer than normal.

What happened to me is very rare. I learned later that C had never had a patient with a uterine inversion in her 30 years of practice. P hadn’t seen one either in 17 years as a midwife and a decade as a labor & delivery nurse before that. Doctors go whole careers without seeing one or count them on one hand. Rare events are difficult to study, and so little is known about the contributing factors. They said there is no way they could have predicted this would happen, and it won't necessarily happen again if I have another labor. I still have a hard time thinking about it though and wondering if there is anything I could have done differently. Thank God I was at the hospital.

Considering the possible outcomes, the uterine inversion was resolved in the best possible way, thanks to the midwife’s quick recognition of the problem and the doctors’ skilled management in the operating room. If they had had to replace it surgically, it would have essentially been like recovering from a C-section AND a vaginal birth. Still, recovery has not been easy, and that's the next part of the story.

About Me

Thirty-something PhD in ecology & evolution, now outside of academia. I've been blogging since the summer before I started grad school, and this blog is about my adventures negotiating the waters of science, becoming a parent, and my life in general.

What? Who?

Jon- my husband

Adele- my daughter born in May 2013

Hometown- As in Jon's Hometown, where we moved in December 2013 to be near his family

Exciting Non-Profit (ENP)- where I work

Big City- where we lived during my Ph.D.U of Big City (UBC)- my graduate institutionUkenzagapia- fictitious African country where I did my Ph.D. research, at my field site NyotaSam- my de facto Ph.D. advisor

Herb- my Ph.D. advisor from U of Big CitySmall Friendly College (SFC)- where I got my B.A. in Biology